title: Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings.
abstract: "The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83% (513/618) of patients that provided feedback, 97% felt PHP was easy to use and 98% easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.
authors.affiliation: National Coalition for Health Professional Education in Genetics, 2360 W Joppa Road; Suite 320, Lutherville, MD, 21093, USA, eedelman@nchpeg.org.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Edelman
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Lin
authors.forename: Teresa
authors.initials: T
authors.lastname: Doksum
authors.forename: Brian
authors.initials: B
authors.lastname: Drohan
authors.forename: Vaughn
authors.initials: V
authors.lastname: Edelson
authors.forename: Siobhan M
authors.initials: SM
authors.lastname: Dolan
authors.forename: Kevin
authors.initials: K
authors.lastname: Hughes
authors.forename: James
authors.initials: J
authors.lastname: O'Leary
authors.forename: Lisa
authors.initials: L
authors.lastname: Vasquez
authors.forename: Sara
authors.initials: S
authors.lastname: Copeland
authors.forename: Shelley L
authors.initials: SL
authors.lastname: Galvin
authors.forename: Nicole
authors.initials: N
authors.lastname: DeGroat
authors.forename: Setul
authors.initials: S
authors.lastname: Pardanani
authors.forename: W
authors.initials: W
authors.lastname: Gregory Feero
authors.forename: Claire
authors.initials: C
authors.lastname: Adams
authors.forename: Renee
authors.initials: R
authors.lastname: Jones
authors.forename: Joan
authors.initials: J
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D003710:Demography; D005260:Female; D005820:Genetic Testing / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment / Q000379:methods*; D012984:Software; D011795:Surveys and Questionnaires; D014481:United States